RESUMO
Vasoconstrictors such as epinephrine or phenylephrine have been used as an adjunct to local anesthetics to prolong the duration of spinal anesthesia. Recently, clonidine, an areceptor agonist, has been proved to have analgesic effect and to prolong epidural and spinal anesthesia. We used 0.3mg of epinephrine, 75 ug and 150 ug of clonidine in spinal anesthesia with 12 mg of T-Cain respectively and compared hemodynamic and analgesic effects of each drug. Heart rate and blood pressure were checked before, during and after anesthesia. Sensory level was checked by pin-prick method and motor blockade was measured by Bromages scale. The results were as follows. 1) Heart rate changed little in the epinephrine group and decreased significantly in all other groups.2) Systolic blood pressure decreased significantly in all groups except the epinephrine group. Both 75 ug and 150 ug of clonidine caused a significant fall in diastolic pressure. 3) The onset time for sensory and motor blockade varied little among all groups. 4) Sensory blockade was significantly higher in the 150 ug of clonidine group than the control group. Time to achieve the maximum level of sensory blockade was significantly faster in control group than 150 ug of clonidine group. 5) The duration of sensory and motor blockade was significantly prolonged in epinephrine and clonidine group than control group. The results indicate that clonidine, when used as an adjunct to T-Cain spinal anesthesia, is as effective as epinephrine in prolongation of motor and sensory blockade.
Assuntos
Anestesia , Raquianestesia , Anestésicos Locais , Pressão Sanguínea , Clonidina , Epinefrina , Frequência Cardíaca , Hemodinâmica , Fenilefrina , VasoconstritoresRESUMO
In order to study the effect of spinal morphine on the tourniquet pain, 40 patients scheduled for orthopedic surgery on the lower extremity under spinal anesthesia were allocated randomly to two groups. In the experimental group, 20 patients received hyperbaric T-cain 10 mg and morphine 0.3 mg (0. 15 ml). In the control group, 20 patients received T-cain 10 mg and saline 0.15 ml. The levels of analgesia and motor block were similar in both groups. During surgery, patients in both groups did not complain of tourniquet pain, whereas one patient in the control group required general anesthesia for surgical pain although the sensory block extended to T(7). In the recovery room, when the sensory block had regressed to the Tdermatomal level, the pain response was checked on the contralateral unoperated thigh in a 60 min tourniquet pressure experiment (350 mmHg for 20 min, 0 mmHg for 20 min, 350 mmHg for 20 min). Seventeen patients in the experimental group experimenced no pain in this test, compared with four patients in the control group. From this study, it is suggested that intrathecal morphine prevents tourniquet pain and it may have some inhibitory effect on tourniquet pain transmission at the spinal cord level.
Assuntos
Humanos , Analgesia , Anestesia Geral , Raquianestesia , Extremidade Inferior , Morfina , Ortopedia , Sala de Recuperação , Medula Espinal , Coxa da Perna , TorniquetesRESUMO
T-can is one of the most widely available local anesthetics for spinal anesthesia in Korea and we use T-cain almost exclusively. However, some anesthetists prefer other local anesthetics such as dibucaine, bupivacaine, or lidocaine for spinal anesthesia. We examined the hemodynamic effects, onset, spread, and duration of sensory and motor blockade following spinal anesthesia with 0.5% T-cain, 0.24% dibucaine, and 0.3% dibucaine. The results were as follows: 1) The blood pressure and pulse rate were decreased by all three drugs without significant difference among the three drugs. 2) The onset of sensory blockade was faster with T-cain than with dibucaine. T-cain containing 0.24% dibucaine had faster onset than the 0.3% solution. The spread of analgesia was also more rapid with T-cain than with dibucaine. 3) The motor blockade was significantly faster and more profound with T-cain than with dibucaine. 4) The duration of anesthesia was the shortest with T-cain containing 0.24% dibucaine and the longest with 0.3% dibucaine, but there was no statistical significance. From the above results, T-cain proved to be a more profound and shorter lasting local anesthetic than dibucaine. However, sensory and motor blockade produced by dibucaine were clinically acceptable. Therefore, both T-cain and dibucaine can be clinically available for spinal anesthesia.
Assuntos
Analgesia , Anestesia , Raquianestesia , Anestésicos Locais , Pressão Sanguínea , Bupivacaína , Dibucaína , Frequência Cardíaca , Hemodinâmica , Coreia (Geográfico) , LidocaínaRESUMO
T-cain has been used for spinal anesthesia as a substitute agent for tetracaine for many years in Korea. However, no clinical study has been made since its use was started in 1971. This study was primarily undertaken to assess the clinical effects of T-cain and to compare its effects with tetracaine and lidocaine. T-cain is directly derived from tetracaine by substituting a diethyl group for a dimethyl group in tetracaine and its clinical effects are known to be similar to the tetracaine except for the duration of action of the drug that is 1 and 1/2 times longer than tetracaine. We had 52 cases of spinal anesthesia using T-cain in various doses for various surgeries. The time from the injection of the drug to the complete motor recovery was measured by Bromage scale. The level of sensory blockade checked in the recovery room was variable and unpredictable, and the motor blockade was below the knee joint level in all the cases in spite of variable dosages. As larger doses were given, the longer the duration of the motor blockade was noticed. The use of T-cain for ordinary surgery seems to be inconvenient because of its longer duration of motor paralysis with patients discomfort in the recovery room.